Fri Jan 06 2023

74 articles - From Friday Dec 30 2022 to Friday Jan 06 2023

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Guidelines

Guidelines and related publications, position statements, white papers, technical reviews, consensus statements, etc…

Am J Gastroenterol

ACG Clinical Guideline: Diagnosis and Management of Gastrointestinal Subepithelial Lesions.

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ACG Clinical Guideline: Diagnosis and Management of Gastrointestinal Subepithelial Lesions.

There is insufficient evidence to recommend surveillance vs resection of gastric gastrointestinal stromal tumors (GIST) 2 cm and al nongastric GIST. When exercising clinical judgment, particularly when statements are conditional suggestions and/or treatments pose significant risks, health-care providers should incorporate this guideline with patient-specific preferences, medical comorbidities, and overall health status to arrive at a patient-centered approach.

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ACG Guideline: Diagnosis and Management of Celiac Disease.

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American College of Gastroenterology Guidelines Update: Diagnosis and Management of Celiac Disease.

These patients require a systematic workup to rule out specific conditions that may cause persistent or recurrent symptoms, especially unintentional gluten contamination. Refractory CD is a rare cause of nonresponsive CD often associated with poor prognosis.

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Meta-analysis

meta-analyses and systematic reviews

Aliment Pharmacol Ther

Meta-analysis: Use of proton pump inhibitors and risk of gastric cancer in patients requiring gastric acid suppression.

We found no association between PPIs and gastric cancer in NRS having adequately controlled for confounding. Published studies may suffer residual confounding. Systematic review registration CRD42022335971.

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Systematic review with network meta-analysis: Risk of Herpes zoster with biological therapies and small molecules in inflammatory bowel disease.

In a network meta-analysis, the janus kinase inhibitor tofacitinib, and al janus kinase inhibitors considered as a class, were most likely to increase risk of Herpes zoster infection. Risk increased with higher doses.

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Am J Gastroenterol

Prevalence of Celiac Disease in Patients With Liver Diseases: A Systematic Review and Meta-Analyses.

Nearly 1 in 20 patients each with cryptogenic cirrhosis and cryptogenic hypertransaminasemia have CeD; hence, they should both be considered high-risk groups for CeD. While the prevalence of CeD in those with all-cause cirrhosis is similar to that in general population, it may be worth screening them for CeD because liver pathology has the potential for reversal in them.

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Gastroenterology

Efficacy and Safety of Drugs for Gastroparesis: Systematic Review and Network Meta-analysis.

In a network meta-analysis, oral dopamine antagonists and tachkinin-1 antagonists were more efficacious than placebo for gastroparesis, but confidence in the evidence was low to moderate for most comparisons. There is an unmet need for efficacious therapies for gastroparesis.

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Gut

Diagnostic accuracy of FibroScan-AST (FAST) score for the non-invasive identification of patients with fibrotic non-alcoholic steatohepatitis: a systematic review and meta-analysis.

The results of our meta-analysis show that the FAST score has a good performance for non-invasive diagnosis of fibrotic NASH. Therefore, this score can be used to efficiently identify patients who should be referred for a conclusive liver biopsy and/or consideration for treatment with emerging pharmacotherapies. Prospero registration number CRD42022350945.

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J Hepatol

A critique and systematic review of the clinical utility of hepatitis B core-related antigen.

HBcrAg has a mixed performance and has a poor correlation with HBsAg loss and antiviral therapy, hence HBcrAg results should be interpretated with caution. Impact and implications • Hepatitis B core-related antigen (HBcrAg) has been used to assess management of Chronic Hepatitis B (CHB) patients without a systematic and critical review of its performance • We found that HBcrAg had false positive rate of 9% and false negative of 12-35% raises concerns although larger studies are need for validation • A systematic review showed that the performance of HBcrAg was variable depending on the CHB endpoint; it was excellent to predict HBeAg seroconversion and HBeAg negative chronic hepatitis (versus chronic infection), hence should be used mainly for this but it was poor for relapse after stopping antiviral therapy and for HBsAg loss. • The results of HBcrAg should be interpreted with considerable caution particularly by physicians, researchers, guideline committees and agencies that approve diagnostic tests.

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Original articles

RCT, clinical trials, retrospective studies, etc…

Aliment Pharmacol Ther

Severe colitis in patients with melanoma treated with BRAF/MEK inhibitors.

BRAF/MEK inhibitors can induce severe colitis characterised by ulcerations of the right colon.

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TLR8 agonist partially improves IFN- deficiency of NK cells in chronic hepatitis B through the synergy of monocytes.

In patients with CHB, targeting TLR8 partially rescues the IFN- insufficiency in NK cells. However, NK cells show an inhibitory response to TLR8 agonist stimulation. TLR8 agonist combined with NA may enhance the antiviral effect of NK cells.

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Am J Gastroenterol

A Randomized, Controlled Trial of Fibrin Glue to Prevent Bleeding after Gastric Endoscopic Submucosal Dissection.

This trial failed to show a preventive effect of fibrin glue on overall post-ESD bleeding in high-risk patients. However, the secondary outcomes suggest a potential sealing effect of fibrin glue during the acute period.

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Fecal microbiota transplantation across the lifespan: balancing efficacy, safety, and innovation.

There are unique concerns regarding FMT as it pertains to children, adults, and the elderly. In this review, we seek to update clinicians, researchers, and regulators on how these factors must be balanced across the lifespan as we move forward with this innovative therapy.

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Liver-Related Mortality in Hepatitis B Virus Core Antibody+/Hepatitis B Virus Surface Antigen- Patients: Occult Hepatitis B Virus, Hepatitis B Virus Reactivation, and Hepatocellular Carcinoma Development.

Antiviral prophylaxis should be initiated in isolated anti-HBV core antibody patients receiving high-risk chemotherapy or biologics. Hepatocellular carcinoma surveillance with liver ultrasound and serum alpha-fetoprotein should be considered for patients with risk factors.

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Quality Indicators for the Diagnosis and Management of Eosinophilic Esophagitis.

We identified highly valid EoE quality indicators for adult gastroenterologists, which can be used for quality improvement with resulting benefits for patient outcomes.

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Randomized Trial of Tenofovir With or Without Peginterferon Alfa Followed by Protocolized Treatment Withdrawal in Adults With Chronic Hepatitis B.

PegIFN combined TDF followed by protocolized TDF withdrawal led to earlier but not higher percentages of HBsAg clearance. Pretreatment HBeAg positivity and subgenotype A2 were strongly associated with HBsAg clearance.

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Regression of Hepatic Fibrosis Following Endoscopic Gastric Plication in Nonalcoholic Fatty Liver Disease.

Endoscopic gastric plication appears effective at treating NAFLD, with significant reduction in NITs of hepatic fibrosis even in patients with cirrhosis.

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REMIT-UC: Real World Effectiveness and Safety of Tofacitinib for Moderate-to-Severely Active Ulcerative Colitis.

One-third of UC patients treated with tofacitinib achieved clinical remission with few serious adverse events. However, half of patients lost response with de-escalation, which was only partially recaptured with increasing the maintenance dose. Those with negative prognostic factors should be counselled about the risks and benefits of continuing high dose tofacitinib.

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Response-guided Therapy with Cefotaxime, Ceftriaxone, or Ciprofloxacin for Spontaneous Bacterial Peritonitis: A Randomized Trial.

The efficacy of empirical antibiotics, such as cefotaxime, ceftriaxone, and ciprofloxacin, against SBP was not significantly different. In addition, these antibiotics administered based on response-guided therapy were still efficacious as initial treatment for SBP, especially in those with community-acquired infections.

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Gastroenterology

CagA-specific gastric CD8+ tissue-resident T cells control Helicobacter pylori during the early infection phase.

Our results point towards a hitherto unknown role of CD8 + T cell response in this bacterial infection, which may have important clinical implications for treatment and vaccination strategies against H. pylori.

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Constitutional microsatellite instability, genotype, and phenotype correlations in Constitutional Mismatch Repair Deficiency.

We present a cheap and scalable cMSI assay that enhances CMMRD detection relative to existing methods. cMSI score is associated with MMR genotype but not phenotype, suggesting it is not a useful predictor of cancer risk.

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Gut

Cell-based cccDNA reporter assay combined with functional genomics identifies YBX1 as HBV cccDNA host factor and antiviral candidate target.

Our cell-based reporter assay enables the discovery of HBV cccDNA host factors including YBX1 and is suitable for the characterisation of cccDNA-related host factors, antiviral targets and compounds.

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Changes in signalling from faecal neuroactive metabolites following dietary modulation of IBS pain.

In a subset of IBS patients with improvement in abdominal pain following a LFD, there is a decrease in pronociceptive signalling from FS, suggesting that changes in luminal mediators may contribute to symptom response.

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Distinct single-cell immune ecosystems distinguish true and de novo HBV-related hepatocellular carcinoma recurrences.

True and de novo HCC recurrences occur early, have distinct TIME and may require different immunotherapy strategies. Our study provides a source for genomic diagnosis and immune profiling for guiding immunotherapy based on the type of HCC recurrence and the specific TIME.

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Empirical rescue treatment of Helicobacter pylori infection in third and subsequent lines: 8-year experience in 2144 patients from the European Registry on H. pylori management (Hp-EuReg).

Empirical rescue treatment in third and subsequent lines achieved suboptimal effectiveness in most European regions. Only quadruple bismuth-metronidazole-tetracycline (10-day single-capsule or 14-day traditional scheme) and triple amoxicillin-levofloxacin therapies reached acceptable outcomes in some settings. Compliance with empirical therapy optimisation principles is still poor 5 years after clinical practice guidelines update.

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Gut microbiota influence anastomotic healing in colorectal cancer surgery through modulation of mucosal proinflammatory cytokines.

Gut microbiota plays an important role in surgical colonic healing in patients with CRC. The impact of these findings may extend to a vast array of invasive gastrointestinal procedures.

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Lifestyle factors for the prevention of inflammatory bowel disease.

Across six US and European cohorts, a substantial burden of inflammatory bowel diseases risk may be preventable through lifestyle modification.

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MicroRNA-223 attenuates hepatocarcinogenesis by blocking hypoxia-driven angiogenesis and immunosuppression.

The miR-223 plays a critical role in modulating hypoxia-induced tumour immunosuppression and angiogenesis, which may serve as a novel therapeutic target for HCC.

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Post COVID-19 irritable bowel syndrome.

Compared with controls, hospitalised patients with COVID-19 had fewer problems of constipation and hard stools at 12 months after acute infection. Patients with COVID-19 had significantly higher rates of IBS than controls.

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J Hepatol

Discovery of a first-in-class orally available HBV cccDNA inhibitor.

We have discovered a small molecule cccDNA inhibitor that reduces HBV cccDNA levels. cccDNA inhibitors potentially represent a new approach to completely cure patients chronically infected with HBV. IMPACT AND IMPLICATIONS cccDNA persistence in HBV-infected hepatocytes is the root cause of chronic hepatitis B. We discovered a novel small molecule cccDNA inhibitor that can specifically reduce cccDNA levels in HBV infected hepatocytes. This type of molecule offers a new approach to completely cure patients chronically infected with HBV.

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J Neurogastroenterol Motil

Effects of tegoprazan versus esomeprazole on nighttime heartburn and sleep quality in GERD: A multicenter double-blind randomized controlled trial.

Tegoprazan may induce faster relief of nighttime heartburn symptoms and may improve sleep disorders associated with nighttime heartburn. Further large-scale studies are required to validate our findings.

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Neurogastroenterol Motil

Chronic opioid users with dysphagia are indistinguishable from symptomatic nonusers on functional lumen imaging probe evaluation.

Symptomatic chronic opioid users have FLIP diagnoses that are similar to nonusers, despite higher perceptive symptoms and worse quality of life. Dominant symptoms improve both in chronic opioid users and nonusers following treatment directed by FLIP.

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Experiencing multiple concurrent functional gastrointestinal disorders is associated with greater symptom severity and worse quality of life in chronic constipation and defecation disorders.

Functional gastrointestinal disorders comorbidity is highly prevalent in chronic constipation and defecatory disorders, and this is associated with greater symptom severity and worse QoL. Multimodal treatments targeting comorbid FGIDs may lead to superior outcomes.

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History of trying exclusion diets and association with avoidant/restrictive food intake disorder in neurogastroenterology patients: A retrospective chart review.

History of following an exclusion diet was common and was most often patient-initiated among pediatric and adult neurogastroenterology patients. As patients with self-reported exclusion diet history were over three times as likely to have ARFID symptoms, providers should be cognizant of this potential association when considering dietary interventions.

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Measuring esophageal compliance using functional lumen imaging probe to assess remodeling in eosinophilic esophagitis.

FLIP provides an objective evaluation of biomechanical properties of the esophageal wall that appears enhanced by complementary application of metrics of DP and esophageal body compliance.

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Reviews&Editorials

Plenty of the editorials are available as full text through the publisher website using the provided link

J Hepatol

Expanding the roles of the renin-angiotensin system: drug-induced liver injury.

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Genetic data not yet a "game-changer" for predicting individualised hepatocellular carcinoma risk.

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Neurogastroenterol Motil

Placebo effects in functional dyspepsia: Causes and implications for clinical trials.

The review sets the scene for their work by putting it in the context of other disorders of brain-gut interaction and extra-gastrointestinal disorders. The review canvasses potential mechanisms of placebo response.

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Targeting the pylorus in gastroparesis: From physiology to endoscopic pyloromyotomy.

As such, a new therapeutic strategy targeting the pylorus, namely endoscopic pyloromyotomy (G-POEM), has received increasing attention and emerged as a promising treatment for gastroparesis. Purpose The present review details the involvement of the pyloric pathophysiology in gastroparesis, as well as clinical results of G-POEM according to the current literature.

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Miscellaneous

misc publications eg case reports, tools of the trade, images of the month, etc…

Am J Gastroenterol

ACG Presidential Address 2022.

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Calendar of Courses, Symposiums and Conferences.

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CME Information.

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Hemorrhagic acute cholecystitis causing Mirizzi's syndrome.

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Peroral Endoscopic Myotomy for Infantile Esophageal Achalasia: The First Case Treated With an Ultrathin Endoscope.

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Response to Singh et al.

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Surveillance for colorectal neoplasia in inflammatory bowel disease: When to stop.

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The Tailored Approach to Manometric Esophagogastric Junction Outflow Obstruction: Treat the Clinical Diagnosis, Not the Manometry Pattern.

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Clin Gastroenterol Hepatol

Cultivating Cultural Competency in Gastroenterology Practices.

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Practice Management: Fulfilling Trainee Education While Maintaining a High Quality Endoscopy Unit.

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Gastroenterology

A Rare Cause of Gastrointestinal Bleeding after Pancreaticoduodenectomy.

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A rare cause of rapid death in patients with Crohn's disease.

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A woman case with chronic anemia, hypoalbuminemia, and ileo-ileal fistula.

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An unintentional pelvic mass --An unexpected diagnosis.

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An Unusual Case of Acute Upper Gastrointestinal Bleeding.

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An Unusual Cause of Portal Hypertension.

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An unusual cause of refractory gastric ulcer.

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An Unusual Cause of Vomiting in Pregnancy.

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An Unusual Etiology of Bleeding in an IBD Surveillance Colonoscopy.

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An Unusual Sequela of Longstanding Gallstone Disease.

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Disseminated ulcerative nodules with elevated liver enzymes.

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For consideration as Gastro Curbside Consult in Gastroenterology: An unusual manifestation of elevated liver enzymes and architecture.

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Localized Gastric Wall Thickening: It's Not What You Think.

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Painful Nodules and Chronic Abdominal Pain: An Unusual Cause.

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The bull's-eye sign in liver: Are they liver metastases?

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Gut

Disentangling tryptophan metabolism in inflammatory bowel diseases.

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Engineered IFN-a and anti-PDL1 containing compounds to target the liver and restore antiviral protection for HBV cure.

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Innumerable nodules in all parts of the small intestine.

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Meltdown of the cold tumour microenvironment: a new 'translational' approach to augment immunotherapy efficacy.

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Letters&Replies

Letters to the editors and authors’ replies

Gut

AGR2 protein expression in colorectal tumour epithelialcompartment.

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Cut-off value of clarithromycin resistance in the treatment of Helicobacter pylori infection: how low is low?

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J Hepatol

Carvedilol in patients with compensated cirrhosis: the ongoing benefits of definitive randomised trials over meta-analysis in patients with small varices.

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In Reply: Is NAFLD a key driver of brain dysfunction?

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Mind the prevention paradox.

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